Promoting Healthy Weight in Pregnancy and Postpartum among Overweight/Obese Women

描述（由申请人提供）：美国近四分之三的非裔美国女性和一半的非西班牙裔白色育龄女性超重或肥胖。大约一半（46%）的孕妇超过了妊娠期体重增加的建议。这个问题是重要的，因为过度妊娠体重增加是一个强大的风险因素，新的或持续的肥胖症的妇女和增加妇女的风险，产妇并发症。此外，越来越多的观察性研究表明，母亲妊娠期体重增加与后代出生体重增加有关，这种情况在儿童期、青春期和青年期持续存在。新的干预方法有可能帮助超重/肥胖的经济上处于不利地位的妇女在怀孕期间和怀孕后实现健康的体重控制，并改善其后代的健康。我们经验丰富的多学科团队将在我们充满希望的R21可行性研究的基础上，实现以下具体目标：（1）检查生活方式干预对超重和肥胖妇女妊娠期体重增加和产后体重减轻的影响，（2）检查干预对体力活动（PA）、饮食摄入和生活质量（QOL）的影响，（3）检查妊娠期总体重增加、PA、饮食摄入和QOL的种族差异;（4）检查干预对后代肥胖的影响。将从南卡罗来纳州哥伦比亚的7家产科诊所招募孕妇（N=500），一半为非洲裔美国人，一半为白色人，并随机分配至生活方式干预组（n=250）或标准护理组（n=250）。基于社会认知理论的生活方式干预将针对定期体重自我监测和增加PA以及怀孕和产后的健康饮食习惯。生活方式计划将在怀孕15周内开始，并将持续到产后6个月。在怀孕期间，干预将包括一个单独的会议，然后是12个基于小组的会议，增加了12个播客，电话随访和社交媒体支持。在产后，干预将包括一个单独的会议（6周），然后是16个播客，电话和社交媒体支持，直到产后6个月。所有女性将在妊娠早期（d15周）、妊娠32周、产后6个月和12个月进行评估，并在6个月和12个月评估后代。这项研究具有创新性，因为它包含了大量文献中缺失的关键组成部分。也就是说，它在理论上是有根据的，除了健康饮食外，还完全针对PA，客观地测量PA，跨越怀孕到产后，包括超重或肥胖的种族和社会经济弱势妇女，有能力评估干预有效性的种族差异，考虑儿童肥胖的代际联系，并将最先进的行为策略和方法与创新的干预渠道相结合（即，播客和社交媒体支持），所有这些都是为来自东南部一个孕产妇和儿童健康指标较差的州的独特妇女群体量身定制的。

DESCRIPTION (provided by applicant): Nearly three-quarters of African American women and half of non-Hispanic White women of childbearing ages in the US are overweight or obese. About one-half (46%) of pregnant women exceed gestational weight gain recommendations. This problem is significant because excessive gestational weight gain is a strong risk factor for new or persistent obesity in women and increases a woman's risk for maternal complications. Furthermore, accumulating observational studies show that higher maternal gestational weight gain is associated with higher offspring birth weight, which persists in childhood, adolescence, and young adulthood. Novel intervention approaches have the potential to help overweight/obese financially disadvantaged women achieve healthy weight control during and after pregnancy and improve the health of their offspring. Our experienced multidisciplinary team will build on our promising R21 feasibility study to address the following specific aims: (1) examine the impact of a lifestyle intervention on gestational weight gain and postpartum weight loss in overweight and obese women, (2) examine the impact of the intervention on physical activity (PA), dietary intake, and quality of life (QOL), (3) examine race differences in total gestational weight gain, PA, dietary intake, and QOL; and (4) examine the impact of the intervention on offspring adiposity. Pregnant women (N=500) women, half African American and half White, will be recruited from seven obstetric clinics in Columbia, South Carolina and randomized to a lifestyle intervention (n=250) or standard care (n=250). The lifestyle intervention, grounded in Social Cognitive Theory, will target regular body weight self-monitoring and increasing PA and healthy dietary practices in pregnancy and postpartum. The lifestyle program will start within 15 weeks gestation and will continue through 6 months postpartum. In pregnancy, the intervention will consist of an individual session followed by 12 group-based sessions augmented with 12 podcasts, telephone follow-up, and social media support. In postpartum, the intervention will consist of an individual session (at 6 weeks) followed by 16 podcasts, telephone calls, and social media support until 6 months postpartum. All women will be assessed early in pregnancy (d15 weeks), at 32 weeks gestation, and at 6- and 12-mos postpartum, and offspring will be assessed at 6- and 12-mos. The study is innovative because it incorporates critical components that are missing in the larger literature. Namely, it is theoretically grounded, fully targets PA in addition to healthy eating, objectively measures PA, spans pregnancy to postpartum, includes racially and socioeconomically disadvantaged women who are overweight or obese, is powered to assess race differences in intervention effectiveness, considers the intergenerational linkage on childhood obesity, and integrates state-of-the-art behavioral strategies and approaches combined with innovative intervention channels (i.e., podcasts and social media support), all tailored to a unique population of women from a southeastern state with poor maternal and child health indicators.